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Effectiveness of zinc fortified drinking water on zinc intake, status and morbidity of rural Kenyan pre-school children.

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  • Additional Information
    • Author(s):
    • Publication Information:
      Netherlands
    • Abstract:
      Background: This thesis aimed to assess the contribution of zinc fortified water to zinc intake and bioavailability in children aged 2-6 years from rural Western Kenya. Methods: The investigations comprised a cross-sectional and effectiveness study conducted in rural Western Kenya and a stable isotope study conducted in Switzerland. Firstly, we assessed the baseline prevalence of zinc, iron and vitamin A deficiency in 461 children aged 2-6 years in rural Western Kenya in a cross-sectional study. We conducted a stable isotope study in Swiss adults to determine zinc bioavailability from zinc fortified water produced by a household water purification and fortification device, the Lifestraw Family filter (LSF filter). Furthermore, we conducted laboratory trials to investigate the effect of usage pattern and idle time on zinc elution levels. Next, we investigated the effectiveness of daily consumption of zinc fortified water on zinc intake, zinc status and morbidity in rural Kenyan children 2-6 years old (n=184). Lastly, we used dietary intake data of the children involved in the effectiveness trial to develop food based recommendations that should accompany the introduction of zinc fortified water to ensure overall nutrient adequacy. Results: The results indicated that zinc and iron deficiency were highly prevalent and affected 74% and 61% of the children, respectively. Vitamin A deficiency affected 34% of the children. Inflammation was high in this population and applying published approaches to correct nutrient biomarker for inflammation led to varying estimates of deficiency. Percent decrease in zinc and vitamin A deficiency ranged from 2-19% and 43-78%, respectively, with iron deficiency decreasing by 10% using exclusion method and increasing by 0.6-3.6% by all other approaches. The stable isotope study showed that geometric mean (-SD, +SD) fractional absorption was 65.9% (42.2, 102.4) from fortified water, higher than 9.8% (5.7, 16.7) and 9.1% (6.0, 13.7) when either water was fortified and consumed with maize or when maize was fortified and consumed with water, respectively. Zinc elution was higher in filters used to treat 2 litres/day (4.7±1.6 mg/litre) than 10 litres/day (1.7±0.9) and 20 litres/day (1.3±0.7 mg/litre). Percent increases in zinc eluted after one week storage were 23.4% (2 litres/day), 82.4% (10 litres/day) and 43.1% (20 litres/day). After the second week of storage, zinc elution further increased by 56.9% (2 litres/day), 12.9% (10 litres/day) and 7.5% (20 litres/day), compared to previous week of continuous usage. Daily consumption of zinc fortified water at the rate ~461 ml/day per child contributed 42% and 36% of daily requirements for absorbable zinc in children 2-3 and 4-6 years, respectively. Zinc fortified water decreased overall morbidity (RR=0.91; 95% CI: 0.87-0.96), morbidity due to colds (RR=0.91; 95% CI: 0.83-0.99) and stomach pain (RR=0.70; 95% CI: 0.56-0.89) and a significant reduction for diarrhoea in the per protocol analysis (RR=0.72; 95% CI: 0.53-0.96). There was no treatment effect on plasma zinc concentration and stunting. The final set of FBRs developed comprised unfortified whole grain products (14 serves/week), unfortified fluid or powdered milk (7 serves/week), nuts and seeds (4 serves/week), vitamin A rich vegetables (7 serves/week), other starchy plants (7 serves/week), vitamin C rich vegetables (7 serves/week) and small whole fish with bones (7 serves/week). These FBRs achieved nutrient adequacy for all nutrients except for vitamin A (25% RNI) and folate (68% RNI). Conclusion: We have shown that in areas at elevated risk of zinc deficiency and with limited access to improved water sources, daily consumption of zinc fortified water contributes substantially to daily zinc intake and is effective in reducing prevalence of common infectious morbidity in children.
    • Number of References:
      93 ref.
    • Subject Terms:
      Rural Development;Human Nutrition;Maize;Tropical Diseases;Dairy Science
    • Subject Terms:
    • Accession Number:
      axerophthol, corn, diarrhea, folacin, folate, hypovitaminosis A, microelements, milk powder, nutritional status, scouring, stomach pain, subsaharan Africa, vegetable crops, vitamin A, vitamin A alcohol, vitamin A1, vitamin C
    • CABICODES:
      Water Resources (PP200)
      Human Nutrition (General) (VV100)
      Physiology of Human Nutrition (VV120)
      Nutrition Related Disorders and Therapeutic Nutrition (VV130)
      Prion, Viral, Bacterial and Fungal Pathogens of Humans (VV210) (New March 2000)
      Rural Health (VV550) (New March 2000)
    • Accession Number:
      50-81-7; 59-30-3; 7439-89-6; 68-26-8; 7440-66-6
    • Publication Information:
      Thesis; ISBN:9789462577572URL:http://edepot.wur.nl/375834
    • Accession Number:
      20163354183
    • Copyright:
      ©2016 CAB International
  • Citations
    • ABNT:
      KUJINGA-CHOPERA, P. Effectiveness of zinc fortified drinking water on zinc intake, status and morbidity of rural Kenyan pre-school children. 2016. Wageningen University, Wageningen; Netherlands, 2016. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=lhh&AN=20163354183. Acesso em: 21 set. 2020.
    • AMA:
      Kujinga-Chopera P. Effectiveness of zinc fortified drinking water on zinc intake, status and morbidity of rural Kenyan pre-school children. Effectiveness of zinc fortified drinking water on zinc intake, status and morbidity of rural Kenyan pre-school children. 2016:x + 129. Accessed September 21, 2020. http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=lhh&AN=20163354183
    • APA:
      Kujinga-Chopera, P. (2016). Effectiveness of zinc fortified drinking water on zinc intake, status and morbidity of rural Kenyan pre-school children [Wageningen University]. In Effectiveness of zinc fortified drinking water on zinc intake, status and morbidity of rural Kenyan pre-school children (p. x + 129).
    • Chicago/Turabian: Author-Date:
      Kujinga-Chopera, P. 2016. “Effectiveness of Zinc Fortified Drinking Water on Zinc Intake, Status and Morbidity of Rural Kenyan Pre-School Children.” Effectiveness of Zinc Fortified Drinking Water on Zinc Intake, Status and Morbidity of Rural Kenyan Pre-School Children. Wageningen; Netherlands: Wageningen University. http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=lhh&AN=20163354183.
    • Harvard:
      Kujinga-Chopera, P. (2016) Effectiveness of zinc fortified drinking water on zinc intake, status and morbidity of rural Kenyan pre-school children, Effectiveness of zinc fortified drinking water on zinc intake, status and morbidity of rural Kenyan pre-school children. Wageningen University. Available at: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=lhh&AN=20163354183 (Accessed: 21 September 2020).
    • Harvard: Australian:
      Kujinga-Chopera, P 2016, ‘Effectiveness of zinc fortified drinking water on zinc intake, status and morbidity of rural Kenyan pre-school children’, Wageningen University, Wageningen; Netherlands, Effectiveness of zinc fortified drinking water on zinc intake, status and morbidity of rural Kenyan pre-school children, p. x + 129, viewed 21 September 2020, .
    • MLA:
      Kujinga-Chopera, P. “Effectiveness of Zinc Fortified Drinking Water on Zinc Intake, Status and Morbidity of Rural Kenyan Pre-School Children.” Effectiveness of Zinc Fortified Drinking Water on Zinc Intake, Status and Morbidity of Rural Kenyan Pre-School Children, Wageningen University, 2016, p. x + 129. EBSCOhost, search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=lhh&AN=20163354183.
    • Chicago/Turabian: Humanities:
      Kujinga-Chopera, P. “Effectiveness of Zinc Fortified Drinking Water on Zinc Intake, Status and Morbidity of Rural Kenyan Pre-School Children.” Effectiveness of Zinc Fortified Drinking Water on Zinc Intake, Status and Morbidity of Rural Kenyan Pre-School Children. Wageningen University, 2016. http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=lhh&AN=20163354183.
    • Vancouver/ICMJE:
      Kujinga-Chopera P. Effectiveness of zinc fortified drinking water on zinc intake, status and morbidity of rural Kenyan pre-school children [Internet]. Effectiveness of zinc fortified drinking water on zinc intake, status and morbidity of rural Kenyan pre-school children. [Wageningen; Netherlands]: Wageningen University; 2016 [cited 2020 Sep 21]. p. x + 129. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=lhh&AN=20163354183